Pioneers of laryngoscopy: indirect, direct and video laryngoscopy.

Airway management is one of the core skills of the anaesthetist and various techniques of airway management have developed over many years. Initially, the only view of the glottis that could be obtained was an indirect view (indirect laryngoscopy). Late in the 19th century, a direct view of the glottis was obtained via various direct laryngoscopes. Currently, in the early 21st century, there has been a return to indirect laryngoscopy via videolaryngoscopy using a videolaryngoscope. The aim of this paper is to give a historical overview of the development of both direct and indirect laryngoscopy.

Observations on the assessment and optimal use of videolaryngoscopes.

Due to the large number of videolaryngoscopes now available, it might be difficult for novice users to assess the various devices or use them optimally. We have collated the experiences of several airway management experts to assist in the assessment and optimal use of seven commonly used videolaryngoscopes. While all videolaryngoscopes have unique features, they can be broadly divided into those inserted via a midline approach over the tongue and those inserted laterally along the floor of the mouth. Videolaryngoscopes that are placed on the floor of the mouth displace the tongue antero-laterally and flatten the submandibular tissues. They generally require a conventional shaped bougie for tracheal intubation. Videolaryngoscopes that use the midline approach may have an in-built airway conduit for the tracheal tube or may require a 'J-shaped' stylet in the tracheal tube to negotiate the upper airway. This may cause difficulty when the tracheal tube is inserted through the glottis and the tip abuts the anterior wall of the subglottic space. Knowledge of the mechanism used by videolaryngoscopes to achieve laryngoscopy is essential for safe and successful tracheal intubation when using these devices.

Emergency surgical airway in life-threatening acute airway emergencies--why are we so reluctant to do it?

'Can't intubate, can't oxygenate' scenarios are rare but are often poorly managed, with potentially disastrous consequences. In our opinion, all doctors should be able to create a surgical airway if necessary. More practically, at least all anaesthetists should have this ability. There should be a change in culture to one that encourages and facilitates the performance of a life-saving emergency surgical airway when required. In this regard, an understanding of the human factors that influence the decision to perform an emergency surgical airway is as important as technical skill. Standardisation of difficult airway equipment in areas where anaesthesia is performed is a step toward ensuring that an emergency surgical airway will be performed appropriately Information on the incidence and clinical management of 'can't intubate, can't oxygenate' scenarios should be compiled through various sources, including national coronial inquest databases and anaesthetic critical incident reporting systems. A systematic approach to teaching and maintaining human factors in airway crisis management and emergency surgical airway skills to anaesthetic trainees and specialists should be developed: in our opinion participation should be mandatory. Importantly, the view that performing an emergency surgical airway is an admission of anaesthetist failure should be strongly countered.

The Colorado Tobacco-Free Schools and Communities Project.

This article defends the appropriateness of tobacco-free school policies as an effective tool toward ensuring young people develop into healthy and intellectually strong adults, and demonstrates how such a policy can be introduced into a school district. Health education efforts to eliminate tobacco use are widely considered more effective when carried out in concert with school policies and adult role models offering the consistent message that tobacco use is unhealthy and unacceptable. Studies indicate students who attend schools with strict smoking policies are less likely to begin smoking than students who attend schools without such policies. Through research, support, and guidance, the Colorado Tobacco-Free Schools and Communities Project successfully has assisted almost half the 176 school districts in Colorado to adopt such policies.

Acute renal failure after envenomation by the common brown snake.

A non-fatal case of acute renal failure after envenomation by a common brown snake (Pseudonaja textilis) is described. The renal failure required dialysis but resolved rapidly. There were no signs of neurotoxic envenomation or myoglobinuria. A mild disturbance of coagulation was noted with severe thrombocytopenia. This is the first documented case of renal failure (acute tubular necrosis) after envenomation by the common brown snake to present with this clinical picture. It is also the first clinical evidence that an Australian snake venom may contain a direct nephrotoxic component.